ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Neuroendocrinology (28 abstracts)
Metabolic status, body composition and bone mineral density in 85 patients with childhood onset growth hormone deficiency (COGHD) in transition period
Mirjana Doknic 1, , Tatjana Milenkovic 3 , Vera Zdravkovic 2, , Maja Jesic 2, , Sladjana Todorovic 3 , Katarina Mitrovic 2, , Rade Vukovic 3 , Dragana Miljic 1, , Sandra Pekic 1, , Ivan Soldatovic 2, , Marko Stojanovic 1, & Milan Petakov 1,
1Clinic for Endocrinology, Diabetes Mellitus and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia; 2School of Medicine, University Belgrade, Belgrade, Serbia; 3Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia; 4University Children’s Clinic, Tirsova, Belgrade, Serbia; 5Institute of Medical Statistics and Informatics, Belgrade, Serbia.
Transition from childhood to adulthood is particularly important in patients with COGHD mainly because of the associated metabolic abnormalities, inadequate body composition and decreased bone mineral density (BMD). There is a lack of large monocentric studies related to this issue.
Design: Monocentric, observational, retrospective cross-sectional study.
Patients: We collected 85 COGHD patients (58 males, aged 17–26 years) transferred from pediatric to adult endocrinology department from 2005 to 2017. Median age at transfer was 19.9±1.5 years.
Methods: We investigated the metabolic status (glycaemia and insulin in OGTT, HOMA-IR, lipids, HbA1c), body composition (% fat, fat mass - FM and lean body mass – LBM) and BMD (BMD g/cm2, Z score-DXA method) of patients at first evaluation after transfer. Related to the etiology of COGHD, two subgroups of enrolled patients were compared. First subgroup consisted subjects with congenital cause of GHD (CH-COGHD) while second subgroup presented patients with history of hypothalamic/pituitary tumor (TU-COGHD). These subgroups were matched by age, sex and BMI.
Results: CH-COGHD was detected in 64.7% cases, while TU-COGHD, idiopathic and other etiologies were reported in 23.5%, 7.0% and 4.7% of patients respectively. All patients had GH replacement during childhood (duration therapy 5.7±2.0 yrs). The pause in GH replacement was 2.3±1.7 before the transfer. Isolated GHD showed 18.8% cases, multiple pituitary hormone deficiency 65.8% while 9.4% of patients recovered GH axis. Combined pituitary hormonal loss was frequently reported in TU-COGHD (P<0.05). Radiotherapy was performed in 25% of patients with hypothalamic/pituitary tumors. Peak and AUC of insulin in OGTT, HOMA-IR and triglycerids were significantly higher in TU-COGHD (P<0.05). Peak and AUC of glycaemia in OGTT, HbA1c, cholesterol, % fat and FM showed also higher levels in TU-COGHD subgroup, but not significantly (P>0.05). In addition, LBM, BMD (g/cm2) and Z score demonstrated lower values in TU-COGHD subgroup, statistically not significant (P>0.05).
Conclusion: Patients with COGHD caused by hypothalamic/pituitary tumors are at an increased risk for the metabolic syndrome in transition period. Also, they have a tendency to decreased lean body mass and BMD compared to patients with congenital COGHD. Young adults with COGHD after achievement a final height should be carefully monitored by adult endocrinologist in terms of their metabolic balance, adequate body composition and bone status.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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